AB1142 DOES OBESITY PLAY A ROLE IN FOOT INVOLVEMENT IN PSORIATIC ARTHRITIS?
Authors: S. F. Azevedo, C. Mazeda, S. P. Silva, C. Pinto Oliveira, A. Barcelos
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Several studies have reported a higher prevalence of obesity in Psoriatic Arthritis (PsA)<sup>[1]</sup>. Obesity may lead to more weight on the joints, namely on the ankle/foot joints, altered mechanics, and repetitive micro-trauma. Foot involvement is common in PsA, including arthritis, dystrophic nails, toe dactylitis and Achilles enthesitis. Obesity has been found to be associated with higher disease activity and worse functionality scores in PsA patients. <sup>[1]</sup> <h3>Objectives</h3> The purpose of this study was to evaluate the role of obesity in foot involvement in PsA patients. <h3>Methods</h3> A retrospective study including patients with PsA (all patients fulfill CASPAR criteria) followed from January to May 2022, from a Rheumatology Clinic. Patients were divided into two groups: with current or previous foot involvement (assessed clinically or by ultrasound) (group 1) and without current or previous foot involvement (group 2). Sociodemographic, clinical and laboratory data were collected. Obesity was defined as a body mass index greater than or equal to 30 Kg/m<sup>2</sup> and multimorbidity was defined as 2 or more comorbidities. Descriptive analysis was performed using means and standard deviation (SD), medians and Interquartile. range (IQR) for continuous data, and frequencies and percentages for qualitative variables. Clinical, laboratory and radiological findings were compared between patients with and without foot. involvement using parametric and non-parametric tests, with a p-value ≤ 0.05. <h3>Results</h3> A total of 154 patients were enrolled (mean age of 57.08 (±11.54) years and 39.6% were women). Foot involvement was found in 110 patients (71.40%). Obesity was more prevalent among patients with foot involvement – group 1 (40.90% VS 13.64%; p=0.001). Enthesitis was found in 35.10 % of patients with Achilles enthesitis (28%) as the most frequent manifestation. PsA patients in group 1 who were obese had higher prevalence of Achilles enthesitis (p= 0.01). 18.18% of patients had current/previous toe dactylitis and dystrophic nails were found in 37.7% of patients (no differences were encountered between obese and non-obese patients). Multimorbidity were more frequent in PsA patients with foot involvement- group 1 (p=0.04). We found a higher frequency of extra-articular manifestations and higher HAQ disability index values in patients with foot involvement (p=0.03 and p&lt;0.001, respectively). Although we did not find statistically significant differences in the HAQ disability index between obese and non-obese patients with foot involvement, there was a predominance of disability in obese patients. PsA patients in group 1 who are obese have higher C-reactive protein (p=0.01) and higher consumption of non-steroidal anti-inflammatory drugs (p=0.02). We did not find statistically significant differences in swollen and tender joint counts, in conventional and biological DMARDS between obese and non-obese patients in group 1. <h3>Conclusion</h3> Obesity was more prevalent among PsA patients with foot involvement, suggesting its presence may enhance and contribute for foot complaints in these patients. Patients with foot involvement had higher HAQ disability index levels, reflecting the negative impact of foot involvement in daily functionality in these patients. Our study highlights the importance of obesity management in PsA patients with foot involvement. Further studies are needed to develop weight reduction strategies that can applied in clinical practice, in order to improve outcomes related to PsA. <h3>Reference</h3> [1]Azevedo S, Santos-Faria D, Leite Silva J, Ramos Rodrigues J, Sousa Neves J, Peixoto D, Tavares-Costa J, Alcino S, Afonso C, Teixeira F. Obesity, metabolic syndrome and other comorbidities in rheumatoid arthritis and psoriatic arthritis: influence on disease activity and quality of life. Acta Reumatol Port. 2019 Oct-Dec;44(4):322-324. English. PMID: 32281967. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.